标题：自拟健脾益气消癌汤联合腹腔热灌注化疗在结直肠癌腹膜转移患者中的应用

      作者：吴炜，唐文贤，蔺松若，王爱丽，林谋斌    同济大学附属杨浦医院普外科，上海 200092

      卷次： 2024年35卷14期

      【摘要】 目的 探讨自拟健脾益气消癌汤联合腹腔热灌注化疗在结直肠癌腹膜转移患者中的应用效果。方法 选取 2021年6月至2023年6月同济大学附属杨浦医院收治的90例结直肠癌腹膜转移患者作为研究对象，按随机数表法分为观察组和对照组各45例。所有患者均接受常规肿瘤细胞减灭术治疗，对照组患者在常规治疗基础上联合腹腔热灌注化疗治疗，共化疗2次，观察组患者在对照组基础上联合自拟健脾益气消癌汤治疗，从术前3 d开始用药，术后患者可进食流质饮食后再持续用药7 d。比较两组患者术后的肛门排气时间、进食时间、住院天数；比较两组患者治疗前、治疗后(出院时)的血清癌胚抗原(CEA)、糖类抗原 199 (CA199)和 T淋巴细胞亚群CD3+、CD4+、CD4+/CD8+的变化，并比较两组患者治疗期间的不良反应发生率。结果 观察组患者的肛门排气时间、进食时间、住院天数分别为(2.84±0.65) d、(3.27±0.64) d、(7.34±1.58) d，明显短于对照组的(3.55±0.73) d、(3.82±0.56) d、(8.76±1.65) d，差异均有统计学意义(P<0.05)；两组患者治疗后的血清CEA、CA199水平比较差异均无统计学意义(P<0.05)；治疗后，观察组患者的NLR为3.60±0.67，明显低于对照组的4.11±0.75，CD3+、CD4+、CD4+/CD8+分别为(49.05±5.17)%、(31.06±3.51)%、1.17±0.16，明显高于对照组的(46.06±4.83)%、(29.15±3.72)%、1.08±0.14，差异均有统计学意义(P<0.05)；治疗期间，观察组患者的肝肾功能损伤、骨髓抑制、腹胀腹痛、恶心呕吐发生率分别为15.56%、22.22%、26.67%、31.11%，明显低于对照组的 35.56%、44.44%、48.89%、55.56%，差异均有统计学意义(P<0.05)。结论 自拟健脾益气消癌汤联合腹腔热灌注化疗能改善结直肠癌腹膜转移患者免疫功能，降低化疗相关不良反应发生率。
      【关键词】 结直肠癌；腹膜转移；腹腔热灌注化疗；肿瘤标志物；免疫功能；不良反应
      【中图分类号】 R735.3 【文献标识码】 A 【文章编号】 1003—6350（2024）14—1997—04

Application of self-formulated Jianpi Yiqi Xiaoai Decoction combined with intraperitoneal thermoperfusionchemotherapy in patients with peritoneal metastasis of colorectal cancer.
WU Wei, TANG Wen-xian, LIN Song-ruo,WANG Ai-li, LIN Mou-bin. Department of General Surgery, Yangpu Hospital Affiliated to Tongji University, Shanghai200092, CHINA
【Abstract】 Objective To study the application effect of self-formulated Jianpi Yiqi Xiaoai Decoction com-bined with intraperitoneal thermoperfusion chemotherapy in patients with peritoneal metastasis of colorectal cancer.Methods A total of 90 patients with peritoneal metastasis of colorectal cancer admitted to Yangpu Hospital Affiliatedto Tongji University from June 2021 to June 2023 were selected as the study objects, which were divided into an observa-tion group and a control group according to random number table method, with 45 cases in each group. All patients weretreated with conventional tumor cell reduction. Patients in the control group were treated with intraperitoneal thermoper-fusion chemotherapy on the basis of conventional treatment, for a total of 2 chemotherapy sessions, and those in the ob-servation group were treated with self-formulated Jianpi Yiqi Xiaoai Decoction on the basis of the treatment in the con-trol group (the drug was administered 3 days before surgery, and continued for 7 days after taking a liquid diet). The post-operative anal exhaust time, feeding time, and length of hospital stay were compared between the two groups. The chang-es of serum carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), T lymphocyte subsets CD3 + , CD4 + ,CD4+/CD8+ before and after treatment (at discharge) were compared between the two groups. The incidence of adversereactions during treatment were compared between the two groups. Results The anal exhaust time, feeding time, andlength of hospital stay in the observation group were (2.84±0.65) d, (3.27±0.64) d, and (7.34±1.58) d, which were signifi-cantly shorter than (3.55±0.73) d, (3.82±0.56) d, and (8.76±1.65) d in the control group (P<0.05). There was no signifi-cant difference in serum CEA and CA199 levels between the two groups after treatment (P>0.05). After treatment, theNLR in observation group was 3.60±0.67, which was significantly lower than 4.11±0.75 in the control group; the CD3+,CD4 + , CD4 +/CD8 + were (49.05±5.17)% , (31.06±3.51)% , 1.17±0.16, which were significantly higher than (46.06±4.83)%, (29.15±3.72)%, 1.08±0.14 in the control group (P<0.05). During treatment, the incidence of liver and kidneyfunction injury, bone marrow suppression, abdominal distension, abdominal pain, nausea and vomiting in the observa-tion group were 15.56%, 22.22%, 26.67%, and 31.11%, which were significantly lower than 35.56%, 44.44%, 48.89%,and 55.56% in the control group (P<0.05). Conclusion Self-formulated Jianpi Yiqi Xiaoai Decoction combined withintraperitoneal thermoperfusion chemotherapy can improve the immune function of patients with peritoneal metastasis ofcolorectal cancer and reduce the incidence of chemotherapy-related adverse reactions.
      【Key words】 Colorectal cancer; Peritoneal metastasis; Intraperitoneal thermoperfusion chemotherapy; Tumormarkers; Immune function; Adverse reaction